Provider Demographics
NPI:1982719225
Name:LIN, CHARLES CHENG-WEN (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHENG-WEN
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:CHENG-WEN
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1034 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3113
Mailing Address - Country:US
Mailing Address - Phone:625-287-8222
Mailing Address - Fax:626-287-4863
Practice Address - Street 1:1034 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3113
Practice Address - Country:US
Practice Address - Phone:625-287-8222
Practice Address - Fax:626-287-4863
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B50264Medicare UPIN
00A346280Medicare ID - Type Unspecified